February 6, 2015
Zambia
In November 2014 Caritas CR sent Czech experts in the health care of mother and child to Mongu in Zambia's Western Province for the second time. The three-member team of medics arrived in the capital Lusaka just in time for flags, bonfires, firecrackers and general merriment. All public spaces were dressed in green, red, black and orange - the four colours of Zambian flag. Yes, it was the 50th anniversary celebration of Zambia’s independence.
The experts and their guides, Caritas workers, left the celebration behind and on the local long-haul bus headed west to Mongu - the city of sun, sand and mangoes. Their destination was Lewanika General Hospital, where Czech doctors and a nurse worked three weeks with local colleagues to improve the health care for mothers, newborns and young children.
The three-member Czech crew was nearly the same composition as the previous year. Specifically, there was MD Petr Šváb, Czech doctors team leader, head of the department of gynecology and obstetrics in Carlsbad Regional Hospital with thirteen years’ operating praxis in Botswana, as well as MD Jiří Halbrštát, chidlren and newborns doctor from the Institute of Mother and Child Care in Prague-Podolí, and Martina Šimůnková, pediatric nurse with an experience in the neonatal intensive care unit in Podolí.
This experienced team, who already knew about local conditions, started to work the day after arriving in Mongu. The daily routine included participation in morning reports and attending to the specific departments later on. Neonatologist Jiří Halbrštát with nurse Martina Šimůnková worked mainly in the puerperium department (the time immediately after the birth of a child). The head physician of the Czech team, Petr Šváb, focused on what was happening in the childbirth department and the delivery room. The team also paid attention to the gynecological, children's and outpatient department. In addition, they went twice into the field to visit remote villages, whose inhabitants are almost completely cut off from any medical help.
A significant part of the Czech medics’ workload was professional training of midwives and some hospital doctors. The team was focused particularly on emergency care in pregnancy, immediate newborn care, neonatal resuscitation, neonatal hypoglycemia, CTG monitoring, stabilization in the delivery room, aftercare and teaching practices related to breastfeeding.
The most serious obstetric complications the team was confronted with, according to Dr. Halbrštát was bleeding episodes. These included antenatal and postpartum hemorrhage, but also eclampsia and hypertension. Of the twelve cases that Czech experts helped to solve was roughly a half were associated with bleeding.
The most frequent neonatal complications those associated with neonatal asphyxia (suffocation), said Dr. Halbrštát. These babies required resuscitation in the delivery room. Statistically interesting was the birth of two children with omphalocele (congenital defect in which the abdominal wall is not adequatelly closed by the navel), which doctor with European praxis rarely encounter. Other situations rarely seen in Europe that Czech team dealt with was imminent rupture of the uterus in a very advanced stage.
Caritas CR supports activities for development in Zambia the region of Mongu in the long term. Dr. Halbrštát says that it is thanks to the charitable projects that some progress can be seen at the Lewanika Hospital and municipal clinics. The doctor also drew attention to the fact that it is sometimes difficult to get his Zambian colleagues to really apply the newly acquired skills in practice. He also said that during the last retraining it was evident that local health workers learn new skills faster. According to him several specific cases showed this. Zambian health workers did a good work, for example, during the stabilization of patients in the delivery room.
To the Czech medics, the most meaningful interventions were structured teaching of resuscitation and emergency care, a structured approach to patients and training through scenarios. In this regard, Dr. Halbrštát highlighted Zambian students’ attitude. In the Czech cultural environment the method of so-called scenario training (ie, training under a particular scenario) sometimes causes embarrassment among students. Zambian healthcare workers, however, approached lectures without prejudice and naturally and actively participated.
His impression confirmed the head nurse of the maternity ward in the Lewanika Hospital, a nun named Lufunda. She believes that the of the Czech team has significantly improved the work standards of her department.
In January 2015 CCR continued in other activities at the Lewanika Hospital. These include sharing experiences between Czech and Zambian teachers at the school for midwives. Caritas Czech Republic has just begun cooperating on a project with the Faculty of Humanities at Tomas Bata University in Zlín. Czech experts’ visits and this year's activities are funded by Caritas Czech Republic through the Czech Development Agency.
